Action Points

Note that this cross-sectional study found that spouses of stroke survivors have lower health-related quality of life compared to spouses of controls, even long after the initial event.

Be aware that most of the stroke patients in this cohort had relatively mild disability.

Caring for a spouse who has had a stroke may have negatively affected the mental and physical health of even relatively young caregivers for many years after the event, researchers reported.

In one of the first follow-up studies to examine the long-term health impact of caring for a stroke survivor, spouse caregivers reported impaired health-related quality of life (HRQoL) during the first years after the stroke and 7 years later, relative to controls matched for age and gender.

Survivors in the study cohort (from the Sahlgrenska Academy Study on Ischemic Stroke) were younger than age 70 at the time of their strokes, and survivor spouses and control spouses (whose partners had not experienced a stroke) had median ages of 64 and 65, respectively.

At 7-year follow-up, spouses of stroke survivors scored lower than control spouses on measures of vitality, mental and general health, social functioning, and physical and social roles, researcher Josefine Persson, MSc, of Sweden's Sahlgrenska Academy at the University of Gothenburg, and colleagues wrote online in the journal Stroke.

The main predictors of the caregiver spouse's health-related quality of life (HRQoL) were the extent of their husband or wive's stroke-related disability and their own age.

"Our results show that the restriction on the spouses own activity and social relationships, previously studied only in shorter perspective, is still obvious for a large proportion of the spouses in a very long perspective," Persson wrote in an email exchange with MedPage Today.

"Our results also highlight the impact on the spouses' mental health due to demanding changes in the life situations of these families, not only during the first years after stroke onset, but also in the long term."

The study included 248 spouses of stroke survivors who were <70 at the time of the event and 245 spouses of matched controls. A total of 65% of spouse caregivers and 66% of control spouses were female.

The majority of stroke survivors had mild impairment of motor function and basic activity, but caregivers still reported poorer mental health several years after the event, compared to control spouses.

Between enrollment and the 7-year follow-up, 16.5% of stroke survivors suffered an additional stroke.

HRQoL was assessed using a standardized Short Form-36 (SF-36) questionnaire, with 8 domains covering various aspects of general health, including physical health (physical functioning, physical role, and bodily pain) and mental health (including vitality, social functioning, emotional role, and other measures).

Among the study findings:

Older spouses of stroke survival scored significantly lower on all eight SF-36 domains than younger spouses of survivors, while older spouses of controls scored lower on physical functioning (P<0.001) and general health (P=0.003) than younger spouses of controls.

No significant differences in HRQoL related to gender were found in the spouses of stroke survivors, but female spouses of controls scored significantly lower than male spouses of controls of physical role (P=0.017), bodily pain (P=0.036), and mental health (P=0.033).

The main predictors of poorer scores on physical domain included older age of the spouses of stroke survivors and more severe global disability of survivors.

Predictors of poorer scores on mental health domains included stroke survivor depression, disability, and cognitive impairment and a perceived lack of social support by the spouse.

Because younger caregivers are more likely than older ones to still have jobs and other family obligations, caregiving responsibilities may be more burdensome and deleterious to their health, the researchers suggested.

"Caring for a spouse after a stroke can be demanding and can reduce a husband or wife's time spent at their occupation, which also can be a burden for younger families," they noted.

The lack of longitudinal data was a potential study limitation, and the researchers concluded that longitudinal studies are needed to better understand the effect of the stroke survivors' disability on HRQoL.

"Among the various recognized disabilities of stroke survivors, it is notable that the depressive symptoms of stroke survivors may adversely affect the mental health of the spouses," they wrote. "Long-lasting support of the family seems to be a challenge for societal efforts."

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